Sunday, January 3, 2010

The Bioethics of Innovation

Behind the rhetoric of containing health care costs are assumptions about the ethics of who gets treatment that need to be challenged. First it is assumed that the high cost of health care is due to growth in the use of and advances in technology. Second, there is a belief that this creates an ethical dilemma by putting advanced care out of the reach of those unable to afford it. However, this turns out to not be true when the evidence is examined. Reason magazine discusses work by economist Frank Lichtenberg on the relationship between technological innovation, life saving and costs.

Key findings from the study as reported by Reason:
Lichtenberg's key finding is that life expectancy increased faster in states that more rapidly adopted advanced diagnostic imaging techniques, newer drugs, and attracted an increasing proportion of doctors from top medical schools.
Second, and this is best quoted from the abstract of Lichtenberg's paper, "States with larger increases in the quality of diagnostic procedures, drugs, and physicians did not have larger increases in per capita medical expenditure." In other words, we find no correlation between increased use of advanced technique and the cost of care.

These findings are important because there are those like bioethicist Daniel Callahan, who explicitly desire the reduction of innovation in our health care system. Some of the ideas of Callahan and his ilk leak into the debate over the shape of the health care system. In his new book Callahan argues that ethical considerations require us to limit innovation. However, when we look at the actual facts this appears not to be so. Here is the money quote from Callahan:
"Cutting the use of technology will seem wrong—even immoral—to many."
Of course it is immoral, because it doesn't contain costs anyway.

Further, think about which world would be the better one to live in. In one, an initially expensive cure for leukemia is found, but costs hundreds of thousands of dollars as it is initially perfected. At first, only the wealthy can afford the treatment and 21,000 Americans die from leukemia the first year after the treatment is proved effective. There is a public outcry, but even as that outcry is building, the cost of treatment drops. Eventually, the cost of treatment comes down to tens of thousands of dollars, and insurance plans start to cover it, but only after the stockholders of the biotech firm that invented the treatment became very rich from the patents. This certainly to unfair and horrible of a world to contemplate.

The alternate world is one in which the research never happens because no venture capital was available to the biotech firm, because innovative new treatments are under strict cost control to limit health care's share of GDP. In fact, if you lived in this second alternative world, you would never be aware of the alternative.

Which world do you want?


  1. Link forthcoming.

    I'm finding the term "bioethicist" to be the most ironic in the most totally unfunny of ways.

  2. nice post. thanks.